DCMedical News: Wednesday, January 30, 2019
DCMedical News-DCMN
Washington, D.C.
Wednesday, January 30, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
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THE BIG STORY IN HEALTH CARE:
The Budget and The Deficit: CBO Director Keith Hall testified (here) before the House Budget Committee Tuesday. “In CBO’s projections, the average deficit over the next 10 years equals 4.4 percent of GDP. That average deficit is not only large but also unusual for times of low unemployment—in contrast to times of high unemployment, when the government sometimes implements policies aiming to stabilize the economy, causing deficits to be larger” and “In closing, I will emphasize that debt is on an unsustainable course in CBO’s projections.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
ACEP Plan to End Balance Billing (“Surprise Medical Bills”): The American College of Emergency Physicians offered a plan (here) to end out-of-network surprise medical bills. Among the proposal specifics, “Prohibit balance billing by not allowing providers to ask for payment for out-of-network emergency care. . . Ensure the patient responsibility portion for out-of-network emergency care is no higher than it would be in-network . . . Take the patient out of insurer-provider billing disputes by creating an arbitration process to settle network issues.”
Vertebral Fractures: The American Society for Bone and Mineral Research issued a task force report (here) which concludes: “Vertebral augmentation is among the current standards of care to reduce pain in patients with vertebral fractures (VF), yet a lack of consensus regarding efficacy and safety of percutaneous vertebroplasty and kyphoplasty raises questions on what basis clinicians should choose one therapy over another. . . . For patients with acutely painful VF, percutaneous vertebroplasty provides no demonstrable clinically significant benefit over placebo. Results did not differ according to duration of pain. There is also insufficient evidence to support kyphoplasty over nonsurgical management, percutaneous vertebroplasty, vertebral body stenting, or KIVA.” New York Times coverage of the report here.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Pre-Existent Disputes: House Ways and Means Committee members (in a hearing on pre-existent conditions) lined up in favor of protection against such conditions (Ds) or opposed to the high cost of health care (Rs). Former Chair Brady and former Health Subcommittee Chair Nunes sent the new (Democratic) Chair a letter (here) indicating that “[W]hile we understand your interest in defending a law Congress enacted nearly a decade ago, the current system contains numerous serious flaws that harm individuals and families. Overall health care costs have continued to escalate, leaving individuals and families exposed to high out-of-pocket costs. Often patients who want to access their personal doctor or local hospital find the plans offered in their area don't give them that choice. The bottom line is the ACA is not working as promised.”
Take That Cop Off the Beat: Eric Hargan, HHS Deputy Secretary, appears today at Brookings to propose weakening Stark fraud and abuse laws and the Anti-Kickback Statute, so as to ease the way for “value-based” payments. Also on the program: Kimberly Brandt, principal deputy administrator for operations at the Centers for Medicare and Medicaid Services; Bobbie Gostout, vice president of the Mayo Clinic; Tim Gronniger, president of Caravan Health; Kevin McAnaney, partner at the Law Office of Kevin McAnaney; Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy; Christen Young, fellow at the USC-Brookings Schaeffer Initiative for Health Policy. A counter-weight, this week’s widely read New Yorker piece (here) on upcoding chicanery in Medicare Advantage plans.
DRUGS AND DEVICES
Part D “Modernization” Rolls Out: The Center for Medicare & Medicaid Innovation is hosting a webinar overview of the Part D Payment Modernization Model on Thursday, January 31, 2019 at 1:00 p.m. EST, and on Wednesday, February 6, 2019 at 1:00 p.m. EST. Pharma reacts (here) against proposals which would allow Part D plans to remove some drugs from one or more of the six “protected classes”; against proposals to allow Medicare Advantage plans to use “step therapy” (mandated serial failure prior to authorization of the drug actually prescribed by the physician); in favor of real-time cost sharing information, but against detailed EOBs with information about lower price alternative drugs; and in favor of patient financial benefit from pharmacy and manufacturer price concession. MedPAC checks in here, endorsing the CMS proposals, indicating how consistent the CMS proposals are with previous MedPAC recommendations.
Just Say “Price Increases Did Not Happen”: Rockpointe’s Policy and Medicine reports that the White House Council of Economic Advisors tweeted two points “regarding the declining price of medicine” in the United States. “The first tweet noted that the prices for prescription drugs fell 0.6% during the 12 months 2018. This is the largest decline in prescription drug prices in almost half a century (46 years). The second tweet discussed inflation, stating that adjusted for general inflation, the prices for prescription drugs fell almost 3% (about 2.8%) during the 12 months 2018.”
READINGS & REFERENCES
National Journal PowerPoint on the Composition of the New Congress: here.
Kaiser Family Foundation graphic on changing Medicaid and private insurance coverage for abortion: here.
U.S. House of Representatives: Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees
U. S. Senate: Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication dates are the regularly scheduled days the House or the Senate is in session.
Remaining January publication dates: 31
February publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.